The meeting was hosted by Western Health CEO Kathryn Cook at the new Sunshine Hospital and made possible by Friends of CAHA and Doctors for the Environment member Dr Forbes McGain and his colleague at Western Health, sustainability officer Catherine O’Shea.

Commissioners Tim Flannery, Lesley Hughes, Roger Beale and Gerry Hueston and Commission media advisor Amanda McKenzie attended the meeting with around 25 people including health professionals from medicine, nursing, allied health, psychology and public health disciplines, as well as health care services and policy people.

Some of the topics of discussion included: What does health sector know about climate change? What can be done to build a greater awareness among health professionals about the risks to health from climate change? What are the opportunities for the health sector to demonstrate leadership in responding to, and being seen to respond to, climate change?

A lack of awareness among health professionals about the implications of climate change for health was raised as a barrier to the sector effectively responding. The education of all health professionals on climate and health was considered vital and urgent – including from undergraduate level to continuing professional development for the existing workforce.

Professor Lesley Hughes presented the findings from the Commission’s report on climate change and health and its latest report on climate impacts and opportunities for Victoria. Professor Tim Flannery explained why they were keen to engage with health professionals: to raise awareness about the implications for health from climate change but also to encourage health professionals to use their own status as respected members of the community to help build community understanding about the need to respond urgently to climate change.

Professor Flannery’s comments to media before the meeting summed this up: “Climate change is one of the serious threats to Victoria’s health, especially those in our community who are most vulnerable, like the elderly and the very young. Few Australians are aware of the risks to their health and the health of their family and community. While much of the public discussions on climate change have emphasised the environmental impacts, a greater focus needs to be on the health consequences. Climate change must be considered a public health priority.”

the quarantining of public health sector budgets separating capital from operational expenditure made it difficult to make the case for the implementation of energy efficiency measures as the impact of costs were felt in one budgetary area and the savings realized in another.

Other socio-cultural challenges include the complex psychological responses to climate change and the difficulties in finding effective ways to communicate such a complex science in ways that are not disempowering and alarming. Serious concerns were raised about the neglect of mental health risks and the lack of preparedness to respond to severe risks to mental health.

The need to engage young people in particular was noted and the importance of including their voices and their concerns in relation to how we respond to climate change.

A lack of climate ‘literacy’ among health professionals was considered a barrier to health professionals understanding the implications of, and the need to respond to, climate change. Education about climate change and health is needed in undergraduate and postgraduate curricula for all health professionals, as well as in continuing professional development for current practitioners, the meeting heard.

There is also a need for the health sector to gain an understanding of the gendered nature of the health implications of climate change and climate policy, especially in relation to the differential effect of climate change on women.

Other concerns were raised about the mistruths being promoted in the community by the Victorian Health Minister David Davis in a recent brochure claiming the carbon tax would hurt health by driving up energy costs.

While there is some degree of preparedness that will help the health sector respond to climate change, with emergency power supplies, and heatwaves plans, overall the health sector is not well prepared to respond to climate impacts. Responses to other risks to health from increased ozone, affecting respiratory health; food and water borne disease and threats to infrastructure from extreme weather event were not well developed and pose potentially serious risks.

Climate Commission media advisor Amanda McKenzie advised health professionals to see the issue as an opportunity for the health sector to make a strong case for action to cut emissions that will also benefit public health and urged health professionals to use their respected and trusted role to build community understanding and action.

Ms McKenzie’s final question to the participants: “What can the Commission do to elevate the voice of health professionals on this issue?” is the subject of continuing discussion, and CAHA will share further feedback from members on this subsequently.

The meeting closed with the message that the climate communications evidence suggests that when climate change is talked about as a health issue, people are much more likely to respond as they see it in an individual context and as something that is personally relevant to them, rather than as a global environmental issue which is distant in time and space (“in the future, someone else, somewhere else”).

Coupled with the evidence that action on climate change can help reduce many existing disease burdens, and the esteem with which health professionals are held in the community, this makes for a powerful combination and a great opportunity for health professionals to influence this national and international conversation to help achieve better outcomes for health and wellbeing.

The Climate and Health Alliance made the following statement to the Productivity Commission’s public hearing in Melbourne for the Commission’s Inquiry into Barriers to Effective Climate Change Adaptation on Monday 16 July 2012:

The Climate and Health Alliance has responded to the Productivity Commission Draft Report on Climate Change Adaptation out of concern that the issue of health protection through effective adaptation is being overlooked in Australia’s adaptation responses and in the Commission’s report.

In 2009, the international medical journal The Lancet identified climate change as the biggest threat to global health of the 21st century.

The risks posed by the increasing frequency and severity of extreme weather events such as heatwaves, fires, floods and storms and the injuries, deaths and trauma – physical, emotional, financial – to health, require careful planning to help minimise harm. Rising temperatures lead to increased harmful air pollution and aeroallergens as well as increased risk of food borne disease; the changing climate affects food and water security; there are increased risks from vector borne diseases; and psychological impacts from a changing environment, ranging from solastalgia from a loss of the familiar natural environment to anxiety about the societal failure to respond, to bereavement, injury, displacement associated with extreme events. Health services are placed under increasing pressure during extreme events; supply chains of pharmaceutical and medical supplied impacted; and health professionals and emergency professionals themselves impacted personally, limiting their ability to respond.

A temperature spike of eight degrees above normal led to 56,000 deaths in the Russian summer of 2010. In 2009, Victoria experienced temperatures between 12-15 degrees above the average. That single heatwave saw a 62% increase in mortality, from both direct heat related illnesses and associated exacerbations of chronic medical conditions. The Victorian Department of Human Services reported that during this five day event, ambulances had a 46% increase in demand; emergency departments experienced an eight-fold increase in heat related presentations; a 2.8 fold increase in cardiac arrests; and a threefold increase in patients dead on arrival.

Monitoring these risks and preparing for them e.g. to track the health consequences of climate change and assess the adaptive processes in place should be an integral responsibility of government. Clear accountability for this responsibility is vital, as is the reporting of such monitoring so it is clear what adaptation strategies are in place and how effective they are.[1]

The fact there is no submission from any health service agencies to this Inquiry reflects the lack of understanding within health departments and the health sector more broadly about the risks posed to health from climate change and the importance of protecting health through effective adaptive responses. We acknowledge and commend the submissions from the National Centre for Epidemiology and Population Health and the Australian Psychological Society which provide important perspectives on health but we regret the lack of broader engagement from other professions and health departments and health service providers. There are in fact excellent examples of some health services demonstrating leadership in helping communities adapt to climate change, such as the Southern Grampians and Glenelg Primary Care Partnership and Women’s Health in the North here in Victoria, but too often these initiatives depend on the passion and commitment of individuals and much more work is needed to institutionalize a responsiveness to climate change across the whole health sector.

This responsiveness however requires an understanding of the issue.

Climate change poses serious risk to health and to health services and yet the understanding of those risks among the professionals groups required to respond is very limited. The lack of engagement with this Inquiry and with the issue itself suggests that health professionals and the healthcare sector have largely failed to grasp the risks posed to Australian communities from a failure to develop effective adaptation strategies or for the need for urgent mitigation.

One of the key strategies for protecting health from climate change must be to enhance awareness of climate change and health among health and medical practitioners. This requires leadership from the instruments of government i.e. the public service in developing policies and programs to address this.

And yet, despite, climate change being the biggest threat to public health we face this century, there is no-one in the federal department of health clearly responsible for developing policy to protect health from climate change. There is no-one in the federal department of climate change who has a clear mandate for policy development that acknowledges and reflects the risks to health. While there has been an energetic public discussion about the need a national policy response to climate change for several years, there has been little acknowledgement by any government of the imperative to protect health though climate policy. The Climate Commission has produced a report on climate change and health, but its messages are yet to reach the majority of health professionals.

Communities can only effectively adapt to climate change is they understand the risks. One of the most cited reports on climate change adaptation in Australia is Community Engagement and Climate Change: Benefits, Challenges and Strategies produced by the McCaughey Centre in the School of Population Health at the University of Melbourne. This report states the development of effective adaptation and responses to climate change require: “assisting citizens and communities develop informed understandings of climate change”, and that key success factors in using community engagement require “government policy frameworks to support and promote community engagement”. While these may appear in a limited way among some local governments, deliberate and sustained community engagement on climate change has been missing in federal government initiatives until the recent establishment of the Climate Commission and sporadic at state government levels.

While there have been some limited evaluations of climate literacy among health professionals internationally, little is known about the level of understanding about climate change among Australian health professionals. International evaluations reveal public health bureaucrats[2] and public health nurses [3] are ill prepared to respond to climate change and have not yet made climate change adaptation a priority. One study of public health department directors in the US suggests climate change adaptation and prevention are not currently major activities at most health departments, and that all will require assistance in making a transition to doing so. The 2012 evaluation of public health nurses’ knowledge and attitudes regarding climate change suggests they lack a thorough understanding of the evidence regarding human induced climate change and its implications.

Improving climate literacy among health professionals is a key adaptive strategy that has so far been overlooked in Australian policy responses. This requires engagement of the existing as well as the future workforce. Continuing professional development programs about climate change and health are needed for the current healthcare workforce, and education of the future health workforce must be made a priority.[4] Curricula for all health disciplines on the health impacts of climate change are needed – all healthcare professionals should be trained from undergraduate through to postgraduate level on how to respond to the risks of climate change to health at the population, community and individual levels. A better understanding among health professionals will also contribute to better community understanding, given the important role of health professionals as communicators, educators, and civil society leaders.

A paper in Australian Health Review by Weaver et al identifies six strategies for preparing the health system for climate change: health promotion; health protection; disaster preparedness; workforce development; strategic and service planning; and healthcare financing.[5]

All these elements require specific focus and additional resourcing in the Australian health sector.

Healthcare infrastructure itself faces risk from climate change.[6] More information is needed about future demand for health services, likely physical impacts on facilities and their ability to cope with these, strategies to improve coping capacity, associated costs, as well as integrated disaster plans to ensure health services can continue to function during extreme weather events.[7]

There are many opportunities for the health care sector to respond to climate change in ways that reduce energy use, reduce waste, save money and improve health. The health sector needs to be supported to begin to implement adaptive strategies that will improve its resilience to climate change impacts, improve its capacity to deliver services and to provide an example of leadership in beginning to demonstrate the economic and health benefits of low carbon operations.

Health care providers should be supported to reduce the environmental footprint of the sector in ways that will protect them from future shocks in terms of energy prices, water shortages and resource shortages. Adaptation measures that create a sustainable and resilient healthcare sector will provide ongoing benefits for the community.

The Climate and Health Alliance recommends:

The development of a National Plan for Health in Responding to Climate Change (Adaptation and Mitigation).

A national community engagement campaign to build understanding about the risks from climate change.

The development and implementation of programs to increase awareness among health professionals about the health risks from climate change to assist in developing more effective adaptive responses.

A substantial increase in the funding available for climate and health research in Australia, including regional health impact assessments, and a specific emphasis on evaluating the health benefits of effective adaptation and mitigation.

Increased investment in research on climate change communication to support translation of evidence into policy action.

[2] Maibach, E.W. et al. Change change and local public health in the United States: Preparedness, Programs and Perceptions of Local Public Health Department Directors, Climate Change and Health, PLoS One, 3:7, 2008.

This post was written by Dr. Pendo Maro, Senior Climate Advisor for Health Care Without Harm Europe and the Health and Environment Alliance; Pendo will attend COP 17 in Durban. It was first published on the blog of Health Care Without Harm, a charity that promotes health care which does no harm to people or the environment.

I was in London on 17 October 2011 attending THE conference on health and security implications of climate change. With over 300 delegates, the meeting brought together ‘soldiers and doctors’, scientists, politicians, business, industry, environmentalists and many others. This is a good indicator that joint efforts to raise awareness about health and climate change within the health sector have taken root. Even more exciting was the statement signed by many participants and many other concerned people calling the EU and other international leaders to take immediate action to address the health and security implications of climate change.

But, health representation both in terms of professionals and substance at international and local climate change debates, policies and outcomes remains poor. We are redressing this. We took a health delegation to the international climate change talks in Barcelona, Copenhagen and Cancun and will be going to Durban. The idea: make sure that health forms a cornerstone of climate change talks and ambitious, binding actions to mitigate and adapt to climate change. And bring the health voice forward. We are doing the same in Europe – work with other civil society groups to advocate for health in the European institutions and in EU member states. Things are moving, albeit slowly.

Many citizens are concerned about this. A recent Eurobarometer poll shows that the European public is more concerned about climate change than the current economic situation, and many believe that tackling climate change can have benefits to employment and growth. So do our elected politicians hear this?

Seriously. We are a few weeks from the international climate change talks, the UNFCCC COP 17 in Durban (28 November – 9 December). Expectations are high that countries will agree to a clear, fair, legally binding treaty to reduce greenhouse gas emissions, a second commitment period to the Kyoto Protocol which expires in 2012. This is the only international legal instrument that sets binding targets to reduce greenhouse gas emissions, covering 37 so-called industrialised countries and the European Union member states. Canada, Russia, and Japan are on the opposition. The USA is not a signatory. Here we go.

On 1 November, the so-called BASIC countries (Brazil, South Africa, India and China) meeting in China agreed to support a second commitment period of the Kyoto Protocol and in their statement called upon the conference in Durban to establish a second Commitment Period to the Kyoto Protocol. Climate finance and the operationalisation of the Green Climate Fund set up in Cancun were other priority issues identified for Durban. The BASIC countries also called on developed countries not Parties to the Kyoto Protocol to undertake comparable emission cuts under the Convention. They pledged to take measures to curb their own emissions. These are good signs. On 4 November, leaders of the major economies, so-called developed countries, meeting at the G20 Summit in Cannes concluded by identifying the need to operationalise the Green Climate Fund as one of the priority outcomes for Durban. Let’s see what they DO in Durban.

What about the EU? Members of the European Parliament (MEPs)’s Environment Committee voted for a resolution on 26 October that calls for support to the continuation of the Kyoto Protocol and called on the EU to work towards finding an agreement on the sources and management of the Green Climate Fund. The MEPs restated their call for the EU to increase its emissions reduction target for 2020, beyond the current 20% emissions reductions compared to 1990 levels. They also want to see new measures to cut aviation and marine emissions. During a recent debate with the EU Commissioner for Climate in the same Committee on 7 November, MEPs called for bold EU action before Durban. These are wise words from MEPs. The Commissioner hears this and talked of finding a common ambitious global solution. The problem is that some EU member states, luckily not all, do not want bold action by the EU, nor for the EU to increase its climate target beyond 20% – for various reasons. But 20% is not enough[1]. And addressing climate change can have benefits to health, the environment and the economy.

Health co-benefits of reducing greenhouse gas emissions, such as those from increasing the EU’s emissions reduction target from 20% to 30% compared to 1990 levels (a 10% increase), can save up to 30.5 billion Euros by 2020. These changes are mainly the result of improved air quality, which promote substantial improvements in respiratory and heart health. Reductions in healthcare costs can be an added incentive as several countries are struggling to balance their budgets and a healthier workforce can contribute to increasing productivity. No time to waste.

This year will see the first ever Climate and Health Summit at an international climate change conference. The Summit, on December 4, co-organised by Health Care Without Harm will take place parallel to the UNFCCC meetings at the Tropicana Hotel in Durban, South Africa. The event will bring key health sector actors from around the world together to discuss the impacts of climate change on public health and solutions that promote greater health, as well as economic equity between and within nations. Reducing greenhouse gas emissions, climate finance, healthcare sector contribution, health co-benefits and many others will feature. One of the outcomes of this Summit is to contribute to the negotiations taking place in Durban, not only by ensuring health representation, but also by making sure that key policy solutions from the Summit make their way to the Conference. Watch this space.

Durban is not the end of the road, said the EU Commissioner for Climate. Indeed, in mid-next year we have the Rio+20 Summit and its ‘green economy’ agenda.

Already the UNDP’s 2011 Human Development report highlights that health and income development in the so-called developing countries are hindered by inaction on climate change and environmental degradation and destruction. We have work to do! Please contact and join us.

The announcement this week that agreement has been reached to pass the first significant piece of national climate policy has been a good news story for the government and generated a modest sense of victory among climate action advocates.

But among all the relief, enthusiasm and general disbelief that the Australian parliament could actually agree on something so sensible as a committment to reducing emissions, it is useful to remind ourselves why we are doing this, what the end goal is, and where we are on the journey so far.

The point of it all, after all, is to reduce emissions, not just arrest emissions growth – and presumably that would be one of the criteria in evaluating the effectiveness of the policy. Also that those emissions reductions are sustained over time, and ultimately lead to zero emissions – given that, according to the science, the Earth is already too hot, and we need to not only cut emissions to zero, we also need to draw down legacy emissions in the atmosphere if we wish to stabilise the climate.

Ahh, the science, you sigh. The pesky scientists! When will they be happy?! Don’t they know how difficult it is to negotiate a politically acceptable deal? Well, yes, but in the realm of physics and atmospheric chemistry, Abbott doesn’t matter, Monkton doesn’t matter, and Andrew Bolt doesn’t matter – atmospheric CO2 just continues to rise, the oceans more acidic and the ice sheets melt, regardless of how politically inconvenient it might be.

And what do the scientists say? Well, Melbourne will have the opportunity to find out this week, with visiting climate experts Hans Schnellnhuber and Malte Meinhausen in town from the Potsdam Institute in Germany. The occasion is “Four Degrees’, a conference hosted by Melbourne University, so named because that’s the lower end of the anticipated rise in global average temperature by the end of this century if we continue on the business as usual path.

A climate that is an average of four degrees hotter is completely unprecedented in human history, and if Schellnhuber’s advice from 2009 is anything to go on – humankind will be “toast” at that sort of rise. The Earth has not been four degrees warmer for the last ten million years, and humans were not around then to test their response to it.[i] But the predictions are that we won’t go so well – Professor Kevin Anderson, director of the Tyndall Centre for Climate Change in the UK, believes only around 10 per cent of the planet’s population – around half a billion people – will survive if global temperatures rise by 4C.

Anderson was fairly frank back in 2009: “For humanity it’s a matter of life or death,” he said. “We will not make all human beings extinct as a few people with the right sort of resources may put themselves in the right parts of the world and survive. But I think it’s extremely unlikely that we wouldn’t have mass death at 4C. If you have got a population of nine billion by 2050 and you hit 4C, 5C or 6C, you might have half a billion people surviving.”[ii]

Meinhausen and others have calculated what volume of greenhouse gas emissions we can pump into the atmosphere between now and 2050 to have a reasonable chance of keeping warming lower than 2°C (above pre-industrial levels). We can only emit 1000 billion tonnes of carbon dioxide (CO2) between the years 2000 and 2050. Trouble is, we’ve emitted a third of that in just nine years.[iii]

If we were to share the total remaining carbon budget equally throughout the world on a per capita basis, Australia would exhaust its budget (as one of the highest per capita emitters in the world) in just seven years.

Our commitment in Australia remains (for now) a 5% reduction in 2020, and 80% by 2050. But the science says, if we were to deal with this in an equitable manner, we need to get to zero in less than a decade.

Just to give some perspective.

So while the carbon price package is welcome, and quite possibly is the best we could get in the current political environment. But let’s not kid ourselves that it is bold, generous, or responsive to the science.

And whose fault is that? Well, that’s just the problem, Australians are all too ready to point the finger elsewhere (at the government, at business, or anywhere – else) and say “they” failed; “they” should have done something else; “they” should have shown some leadership. All that might be true, but parliamentarians will only respond when their constituents demand something of them, and so far, most people in Australia are content to bury their heads in the sand, and pretend it’s not happening, or simply distract themselves by wishing the growth economy back to health, as if continuous economic growth was possible on the back of the loss of natural capital, in the middle of a mass extinction event, when we have gone well into ecological overshoot and are playing pretend that if we use up natural resources faster than they can be replaced that some magical process will make it all right in the end.

At its core, climate change is a health issue. Around 300,000 people are dying each year from climate change.[iv] Around five million more will die in the coming decade if we fail to act effectively.[v] The bulk of the climate health burden (over 80%) falls on children – that’s right, children, who are powerless to make decisions to increase those emissions that are destroying their health and their future; powerless to say “stop, we choose a different future”.[vi] Children, for whom the health burden is not temporary, but for whom early exposure to disease leaves them with lifelong vulnerabilities. Who face higher exposure to pollution per unit of body weight. Who by virtue of having more future years of life face greater threats over a longer period that the rest of us.

Who will advocate for them?

Despite the declaration in The Lancet in 2009 that “climate change is the biggest threat to global public health of the 21st century”, health professionals have so far failed to respond in ways that are proportionate to risk. Public health experts describe a wearied tolerance from other health colleagues when they hold forth on climate change – as though it were some sort of personal hobby horse whereas others in different parts of the sector are “busy saving lives” and “don’t have time for this sort of indulgence”.

Well, that’s regrettable because climate change will eclipse all other threats to health in the coming decades if we don’t turn our attention to finding solutions to the biggest threat there is. We must of course continue to act on existing disease burdens, as many will be (are being) exacerbated by climate change. But this threat is global, it’s enormous, and until the world seriously turns its attention to dealing with it, climate change will bring unprecedented and dramatic negative impacts on human health.

The good news of course is that there is good news. Many strategies to reduce emissions will also bring health gains. This should be also a major source of attention for health professionals – and a focus of their advocacy for action on climate. Because advocating for action on climate change is possibly the biggest contribution health professionals can make to global public health. The health message is one that, despite the best efforts of some, remains missing from the climate policy story. But the evidence suggests that, when framed as a health issue, climate change is more likely to be perceived in an individual context, and people are more likely to support action for mitigation.

We’ve seen a little bit of political leadership on the issue this week. But we mustn’t imagine that’s enough. The job is much, much bigger than that, and the voice of all health professionals, as respected leaders in society, would be very welcome in keeping this trajectory on track, to denounce those who misrepresent the science, and to call for action as civil society leaders to send the clear message to the rest of the community, from people who have no vested interest, that climate action is urgent, and ultimately, it’s good for health.

In all the to and fro of the current carbon pricing debate here in Australia, one important aspect of the story on climate action is missing.

Why are we acting on climate change? Well, because of the evidence that it poses risks to the global economy, to infrastructure, and to our natural environment. All that is true and makes for a compelling case for action. But at its very core – climate change is a health issue.

It places the safety and wellbeing of our species in jeopardy. Climate change is already responsible for the deaths of more than 300,000 people each year.[1] Five million more deaths are expected during the next decade if no effective action is taken to reduce climate risk.[2] Over 80% of the disease burden attributable to climate change falls on children.[3]

The international medical journal The Lancet outlined the stark facts in 2009: that the effects of climate change from global warming “puts the lives and wellbeing of billions of people at increased risk”.

Climate change presents serious immediate and long term threats to the health and wellbeing of the Australian and global population.

The direct health effects of climate change include deaths, injury, and hospitalisation associated with increasingly frequent and intense bushfires, cyclones, storms and floods and heatwaves.[4] Indirect effects include increases in infectious and vector borne diseases, worsening chronic illness, and health risks from poor water quality and food insecurity.[5]

Health care services in Australia are already experiencing dramatic increases in service demand from climate related events, such as heatwaves and floods.[6],[7] The heatwave that preceded the Black Saturday bushfires in Victoria in 2009 saw a 62% increase in mortality from heat related illnesses and worsening chronic medical conditions. During this five day event, there was a 46% increase in demand for ambulances; an eight-fold increase in heat related presentations to emergency departments; a 2.8 fold increase in cardiac arrests; and a threefold increase in patients dead on arrival.[8]

So there are many compelling reasons to act on climate change from the point of view of reducing health risks. This story is missing however from the policy debate – it is missing in the explanations from our leaders about why we must act, it is missing from the narrative of many advocacy groups who imagine that a threat to polar bears will be sufficient to elicit support for action. This is not proving to be the case.

Health is not only one of the most compelling reasons to act on climate change – its actually one of the reasons most people will feel compelled to act on climate change, because framing climate change as a health issue is one of the ways we can best appeal to people’s individual assessment of risk from climate change. Put in a health context, people are far more inclined to consider climate change as an issue that affects them.

And there are many health gains possible from climate action. Reducing our reliance on energy supply from coal and encouraging shifts in transport away from fossil-fuel-guzzling cars to public transport will reduce air pollution, improve social capital and bring concurrent increases in activity which, in turn, all help reduce obesity, osteoporosis, heart disease and diabetes, not to mention road traffic injuries and deaths.

Shifting away from coal as a fuel source for electricity will improve air quality and reduce related deaths from lung cancer and heart disease. Switching to low emissions and more active transport systems can significantly improve air quality and reduce respiratory disease, as well as cut the incidence of obesity, chronic illness and cardiovascular disease. Changing to a diet with lower meat consumption can cut emissions from livestock production as well reduce heart disease and diabetes.[9]

The economic argument for the health benefits of climate action is also very strong: a recent report from the European Union reveals significant health and economic benefits are associated with strong targets for emissions reductions, with a target of 30% reduction by 2020 expected to deliver health care savings from avoided ill health of €80 billion per year.[10]

Effective action on climate change has the potential to significantly reduce the health costs (both economic and social) we will face in the next decade and the coming century. It’s also an important way to build public support for action [11]. If our political leaders were serious about building public support (and acting in the national interest), they would be talking about addressing “the biggest threat to global health of the 21stcentury”,[12] not talking about compensating polluting industries.

Given the hysteria around the current debate on a carbon tax, it seems timely to republish on the CAHA blog an edited version of this article published in Fairfax’s National Times last year: No need to be afraid of a tax on carbon.

The agreement between The Gillard Government and The Greens that a carbon price is paramount to tackling carbon pollution signalled a restoration of a significant climate policy agenda in Australia. It was well overdue, given the overwhelming recognition that a carbon price is central to effective emissions reductions.

This has been the case since Sir Nicholas Stern’s landmark report in 2006, which identified a carbon price as a key element to cutting emissions. And despite independent MP Bob Katter’s poor opinion of Sir Nicholas (describing him in 2010 as “a lightweight”), Stern remains a pre-eminent expert on the economics of climate change.

Nothing has changed since his report in terms of the need for a carbon price; only the urgency of its application has increased.

Achieving this in Australia, however, has been difficult to date – the Carbon Pollution Reduction Scheme (CPRS) was a miserable attempt at pricing carbon, and its flawed approach (rejected quite rightly by The Greens and others) with inadequate targets, excessive use of offsetting and unnecessary compensation to polluters, has contributed to the discrediting of emissions trading as the preferred option for pricing carbon internationally.

While Opposition Leader Tony Abbott remains vehement in his opposition to new taxes, he doesn’t (yet) appear to understand that his policy of direct investment is just another way of putting a price on carbon. And while Abbott may be opposed to the idea of a specific carbon tax, the allocation of funds to reduce carbon emissions is using revenue collected through taxation.

To argue that we shouldn’t have a carbon price because it will drive up electricity prices is nonsense – electricity prices are already going up and will go up even further without a carbon price, because there is no incentive to invest in energy generation infrastructure while there is uncertainty around a price on carbon. Capital expenditure on power generation in Australia is expected to decline $10 billion over the next five years unless there is a price on carbon.

In terms of actual mechanisms, the most appropriate tool is a carbon tax. Supported by most environmental economists (and others such as Nobel Laureate Joseph Stiglitz and Jeremy Sachs), a carbon tax is already in place in many European jurisdictions where it has reduced emissions while maintaining, even improving in some instances, economic productivity.

Most arguments against a carbon tax incorrectly identify the misplaced allocation of funds as a flaw of the mechanism itself, rather than its faulty implementation. A carbon tax is a way of obtaining revenue (appropriately, by taxing polluters). What is done with that revenue determines what its impact will be on the community, whether it is supporting low income or vulnerable households or supporting the expansion of renewable energy technologies – not the tax itself. Its popular appeal could also be enhanced by reducing other taxes, such as income taxes, while maintaining the pressure on polluters to find ways to cut emissions.

The “anti-tax” position adopted by Abbott is a very simplistic argument. A carbon tax will provide a revenue base that we can use to diversify our economy away from a ”quarry and dump” to potentially manufacturing, operating and exporting renewable energy infrastructure – creating thousands of jobs and bringing wealth to our deprived regional areas.

We are witnessing of course the inevitable squealing from the emissions intensive industries, and re-runs of the “sky is falling” argument by the big polluters. The reality, however, is that ongoing opposition to a price on carbon will mean we better steel ourselves for the “brownouts” that will result, not because of the carbon price, but because we lack one. The failure or unwillingness to invest in new power generation will inevitably lead to considerable economic disruption and societal dysfunction.

But while a carbon price is central, it is only one tool in the suite of policy options that are needed to bring down emissions, help make clean renewable energy cheaper, and discourage polluters from dumping their waste in the atmosphere. We need to move quickly to a suite of policy mechanisms that not only make clean renewable energy competitive with fossil fuels but will also reduce emissions from transport and building stock and agriculture.

To achieve this it is vital that we legislate a carbon price and move on from the argument about a carbon tax versus emissions trading. We must seek the establishment of a national plan to guide Australia’s transition to a low carbon and then zero carbon economy. Other more responsible countries are investing in whole of society transition plans – recognising that transition is inevitable and, carefully managed, it will bring far more positive outcomes than ad hoc adaptation and emergency responses.

We’ve had enough of intermittent commitment to individual policy mechanisms – it is time for a considered framework that will guide our country’s transition to the low and then zero emissions society that promotes and protects our economic, environmental and social wellbeing.

It is unfortunate that a serious family illness prevented Richard Smith from delivering the Redfern Oration for the World Congress of Internal Medicine in Melbourne last year, but problems are opportunities in disguise.

He did not increase his ecological footprint but, thanks to webcasting, he delivered his address from his home in the antipodes and this has also enabled many more people than would otherwise have been the case to read and view his important 10 lessons as follows:

Lesson one: Modern clinical medicine is as out of control as the banks and is unaffordable globally.

Lesson two: Inequalities in our world are gross and need to be tackled.

Lesson three: The Victorians eventually couldn’t live with the difference between rich and poor, and we got income tax with substantial transfers of wealth within countries. We now need such transfers between countries.

Lesson four: You can’t have healthy people without healthy places.

Lesson five: We may not like to think in terms of money, but we have to pay close attention to costs—returning to the utilitarian roots of public health.

Lesson six: How we die may make a huge difference, and there are positive signs of the compression of morbidity. We must promote the idea that death is normal and a friend.

Lesson seven: New challenges need new ways of thinking and behaving.

Lesson eight: ideology can get in the way of progress.

Lesson nine: developing countries don’t have to follow the disastrous path of developed countries but can leapfrog their failures.

Lesson ten: the rich can learn from developing countries.

It is lesson 4 that has particular relevance to CAHA as Richard explains, “…healthy places will begin to disappear as our planet becomes sicker. We need a healthy planet in order to have healthy places, and luckily what is good for individuals—avoiding motorised transport and exercising more and eating more fruit and vegetables and fewer animal products– is also good for the planet.”

But all the lessons are relevant to CAHA. For example one of the key messages from the Marmot Review was that tackling social inequalities in health and tackling climate change must go together.

The message for me is that the major changes required to tackle failing health systems and the urgent need to develop alternate approaches is interconnected with the need to do the same for climate change.